MEDICARE: DR. DAVID S HALLEGUA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	A55599	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A555990	OTHER	CA	BLUE SHIELD
2	954869287	OTHER	CA	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063416964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S HALLEGUA M.D.

Provider Business Mailing Address
First Line	:	8641 WILSHIRE BOULEVARD
Second Line	:	STE 301
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2921
Country	:	US
Telephone Number	:	310-652-0928
Fax Number	:	310-659-2841

Provider Business Practice Location Address
First Line	:	8641 WILSHIRE BOULEVARD
Second Line	:	STE 301
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2921
Country	:	US
Telephone Number	:	310-652-0928
Fax Number	:	310-659-2841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/17/2020

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